Wednesday, May 29, 2013

Post-Workout Recovery - Dealing With DOMS

I've been getting a lot of questions lately about recovery following a workout. This one pairs off pretty well with my Injury Prevention post because the best thing you can do to aid recovery is train intelligently and prevent injury. Thats number one. Preventing injury should be the highest priority of any athlete. It doesn't matter how much you can pull or how fast you can run a 40 if you have a blown out knee and a surgically repaired shoulder. I've seen promising collegiate athletic careers tossed out a window simply because a trainer pushed their client too hard and neither the client nor trainer had the good sense to say, "we should slow down."

I think the word "recovery" may mean different things to different people so I'm going to define it insofar as it will be used here. The question's I've been getting seem to deal mostlyl with pain management or the ability to ease delayed onset muscle soreness (DOMS). If you've ever worked out with any kind of intensity you're probably familiar with DOMS. It can range from mildly annoying to almost paralyzing depending on it's intensity. Luckily, there is very little evidence to demonstrate that DOMS has any long term negative effects on your physiology. In fact, there's a fair amount of evidence that suggests that the intensity and duration of DOMS has almost nothing to do with any concurrent muscle damage.

Yes, you read that right. Soreness is not an accurate indicator of muscle trauma. They've done studies where they ask people about their soreness and then evaluate actual muscular trauma either through a muscle biopsy, blood borne markers (creatine kinase and in extreme cases myoglobin) or some level of electronic scan and then statistically evaluate the link between soreness and trauma. The general consensus? There seems to be a positive correlation between soreness and trauma...and that's about it. Any good scientist knows correlation does not imply causation and as such the only real conclusion we can draw about DOMS is that if you feel soreness it's probably because you did some activity. Beyond that there is not a terribly large body of scientific work surrounding DOMS and it's significance or management.

I know that on initial reading it may seem that the only conclusion you can draw from this is that you're basically 'effed and you just have to figure it out. Fortunately, the truth is quite the opposite. I am going to offer you what I can in terms of methods to aid in recovery from a normal workout. It should be noted that I am specifically dealing with general recovery following an athletic event and not injury rehab. That is another topic entirely. There is some cross over, to be sure, but it would be highly unprofessional for me to hand out generic recommendations on how to rehab specific injuries.

THE PILLARS OF PROPER RECOVERY

1) Nutrition - Too often these days the subject of nutrition is directly associated with weight loss. Whether we do it consciously or not, it seems that 90% of the people I know who attempt some level of dietary modification do it for the express purpose of losing weight. Now, that's perfectly acceptable for certain situations but let me offer you this metaphor to explain why, in terms of recovery, it is not always the ideal paradigm.

Your body is a machine. Biological growth can best be defined as assimilation of organic matter. In other words, growth is taking in external organic building blocks and using them to improve the quality, function, and size of your machine. Weight loss generally requires a caloric deficit, you need to burn more fuel than you take in. The problem with this, in terms of recovery, is that if you are constantly at a caloric deficit, you have no calories left over for your body to use as repair materials. This is an incredibly general metaphor that does not deal with the purpose of different macronutrients in your diet but I think the general message still stands: If you are always burning more than you are taking in, you are always breaking your body down. Your body needs nutrients to recover.

-Guidelines for Eating for Proper Recovery-

-Protein Consumption - The recommendations for this are f*cking all over the place depending on who you ask. Registered Dietitians (RDs) tend to recommend 1g/kg of body weight which is in my opinion extremely low. I weigh about 190lbs = 86.2 kilos, so they would recommend 86 grams of protein per day. Honestly, if you are not particularly active and if you don't strength train this may be adequate, I don't know, I haven't eaten like that since high school.

In terms of the fitness community and particularly in strength training circles the general recommendation is 1-2g of protein PER LB of body weight. That means I should shoot for 190-380 g/day. Now 380g may sound a little extreme to some people but it is the general consumption for a large number of strength athletes (olympic/powerlifters). If your main goal is not to get absolutely gigantic, then 2g/lb is probably a bit much. That being said, if you are an active person and you strength train it is my personal belief that you should get at least 1g/lb of body weight. You will recover faster and build more muscle. Plus, 1g protein is only 4 cals so 150g protein is only around 600 calories. It's really not as much as it seems.

There is some indication that taking in a small amount of protein or branched chain amino acids (BCAA's) 30-40min prior to a strength workout will increase protein synthesis following training. In other words, taking a small amount of protein before your workout will improve both your post workout recovery and may lead to increased muscle gain.

-Carbohydrate Consumption- Everyone is carbophobic these days. We went from being terrified of eating fat to realizing all of it's health benefits and now it seems carbohydrates have replaced fat as the popular nutritional scapegoat. Saying that carbs are bad for you is like saying gasoline is bad for an engine. Well, if your engine runs off ethanol, sure, that's a bad idea; or if your gasoline is poor quality probably not too good for it either.

The point is that carbs are not only okay, they are important and necessary. You just have to focus on what type of carbs you're eating. The amount of carbs you need is based heavily on what type of activity you're engaging in. If your exercise tends to be more on the hard and fast side, you could probably use a little bit more CHO to replenish your glycogen stores. Your best option for healthy carbs is produce. Fruit tends to be more on the simple carbohydrate side while a lot of vegetables tend to be more starchy (complex). Simple carbs break down quickly and are easily utilized, meaning they make a great pre-workout snack. Starches and more complex carbohydrates are better for replenishing glycogen stores and fighting hunger. They take a little while longer to break down so you feel full longer. Starches can be found in vegetables like potatoes. Sweet potatoes are one of my favorite foods. Ever. Cruciferous vegetables (broccoli, cauliflower, etc.) tend to be more fibrous. Fiber is an important part of your diet, but it has more to do with overall health and body function than workout recovery specifically.

-Fat Consumption- See entry on carbohydrate consumption. Basically the same rules apply here. It's not about whether fat is good or bad, it's that there are good and bad fats. You should try to get most of your fat calories from healthy sources (walnuts, almonds, fish, avocados, etc.) rather than concentrated saturated fat (fatty cuts of meat) even though a little saturated fat in your diet is healthy. In terms of eating for recovery, you should be eating enough to replenish the fuel you burned.

-Micronutrients (vitamins) - If you eat a healthy, balanced diet that contains a variety of different colored fruits and vegetables and plenty of dark leafy greens you're probably getting the majority of your vitamin needs covered. Vitamins play a whole host of important roles in our body, from acting as co-enzymes in metabolic processes (b-vitamins) to aiding in proper function of your eyes (vitamin A). In terms of athletic performance, if you aren't getting the appropriate levels of these micronutrients you may have all the right fuels and building blocks but you may still be short circuiting the cellular processes that allow your body to use all that good stuff. Personally I'm a huge supporter of getting most nutrients (macro and micro) from natural food sources rather than supplements, but in a pinch a multivitamin and a shot of whey protein are acceptable. In general your body simply tends to absorb nutrients from real food better. (It's this thing called bioavailability...it's...complicated.)

Obviously everyones nutritional needs are different depending on age, size, activity level and choice f activity. The take home message, however, is pretty simple. If you feel that you are not recovering or that your progress is beginning regress, take a look at your diet. If you take your training seriously you should have a good idea where your calories are coming from and how much you're consuming each day. Go through these suggestions and re-evaluate if your calorie and macronutrient allotments are where they should be. I would say that almost everyone I talk to who is a beginner to moderate exerciser (0-3 years of training experience) severely underestimates their protein needs. Start with that and readjust as necessary.

Post workout nutrient timing is also an important factor. Generally speaking you should take in some combination of carbohydrates and protein IMMEDIATELY following an intense workout. The ratios and amounts of carbs to protein is, again, somewhat under dispute, but a common recommendation is 2:1 carbs:protein. A pretty sound recommendation is 40g carbs and 20g protein, although specific needs have to be adjusted for specific situations. If your focus is fat loss you may want to limit or skip the carbs altogether, while if you are supplementing with creatine you may need to take in up to 100g of carbs. Fitness is a field of specificity permeated by generalities. I blame capitalism...and those damn kids...whoever they may be.

2)Post Workout Stretching - Stretching may be one of the most highly debated topics in exercise physiology. The reason is because while it is one of the most common components of exercise programs, there is really no scientific evidence that it has any positive effect on injury prevention or recovery. There is even some evidence that it may hinder progress in strength training by neurologically preparing your muscles to relax rather than fire.

I am referring specifically to static stretching; the type of stretching that involves holding the same position for anywhere from 15 seconds to a minute or two. There is a fair amount of evidence that dynamic/active stretching (warm up activities like walking toe touches or butt kicks) may help prep your body for activity but seeing as how this post is about recovery I'm not really going to address that here. I just felt it was worth mentioning.

So, if stretching doesn't help heal or prevent injury, what is it good for? Fortunately it's great for specifically what we are discussing: pain management. Stretches are an essential part of most orthopedic rehab programs because stretching helps mediate pain. It also leads to increased range of motion and flexibility. Flexibility is a huge component of healthy movement and by ensuring you have a healthy range of motion in your joints you can set yourself up to avoid a whole lot of pain and injury.

In general static stretches should be held for 30-60s each stretch. If you're hurting following a certain workout check out MobilityWod.com for some stretches and get cracking. Or...stretching. Whatever. It may not help you heal faster but it won't hurt you and it may make you feel better. Far as I'm concerned that makes it worthwhile.

3) Self Soft Tissue Mobilization (SSTM) - In addition to our muscles and tendons our entire muscular system is surrounded by these sheathes called fascia. They have become something of a hotbed of scientific research of late as people realize how much the fascia plays into functional performance. There are large camps in both the fitness and exercise physiology world that believe "knots" in your fascia may lead to pain, decreased flexibility and ultimately decreased performance. The most common methods of SSTM are using a foam roller or a lacrosse ball and basically pressing on the knots; attempting to relax your muscle in a way that the knots "melt" away.

I put these words in quotes because I've had conversations with physical therapists that swear by foam rollers and myofascial release and I've had conversations with therapists who think it's all a bunch of hippie garbage. I read an article a week ago that claimed that our fascia is in fact so strong that attempting to manipulate it with anything short of a pair of forceps and a machine is pointless. Seems like a pretty extreme claim but apparently the guy making it runs a laboratory. Me? I'm just over here writing sh*t and yellin' at people.

The point is that the body of science on this stuff is still very young which makes basing any claim about it on scientific evidence dubious at best. Failing the ability to provide you with a scientific basis, what I can offer you is my personal experience. I love my foam roller. I use it several times a week, sometimes multiple times a day particularly if my legs are sore. Sometimes I use it like a rolling pin, rolling back and forth to massage the muscle and sometimes I find a particularly painful knot and just hang out on it, pushing it into the foam roller until it starts to go away. I believe there is also some limited evidence that using it as a massage may help increase blood flow to the areas in need of repair, but I honestly don't remember exactly where I read that. I read a lot. Seems like a reasonable claim considering that most masseuses claim the same thing but I'm not positive about the science behind it.

Does it make me heal faster? I don't really know.

Does it make me perform better? Again, jury is still out.

Does it make me feel better? Yes. Absolutely. Every single time.

I had a hip injury from kickboxing that plagued me for years. Every now and then it still flares up a bit if I'm not careful with my form or if I get a bit overzealous with my intensity. My foam roller has helped me manage the pain from that injury and in my opinion has contributed significantly to my recovery.

The reality, unfortunately, is that this is anecdotal evidence and therefore may be complete bullsh*t. That being said, I love my foam roller and I would recommend it to anyone. It may not help the way we currently think it does, but it's not going to hurt you and once again, it is definitely useful for managing pain.

4) Temperature Therapy - This is a fairly broad category that includes the usage of both hot and cold packs, whirlpools, ice baths and contrast therapy. Luckily this is one subject to which there is a fairly substantial amount of scientific evidence so I can rattle off to you what works and how fairly quickly. Lets do this.

-Ice packs- Ice packs are great for managing pain. They also aid in the reduction of inflammation and swelling. I wouldn't necessarily recommend using them just to deal with sore muscles, but if your DOMS has become so intense it's affecting your routines of daily living it's not the worst thing you could do. In general, however, ice packs are best for injury. They may help you feel better but if you are feeling stiff and achy, the cold temperature is only going to make the joint or muscle more stiff because it causes the tissue to constrict. While this is actually precisely why it helps with swelling and inflammation, it can be counter productive in terms of restoring lost mobility.

-Hot packs- Hot packs, and I guess this is probably obvious, basically do the exact opposite of what Ice packs do. While they are not the best for intense swelling and inflammation, they can be useful in aiding mobility. The heat causes vasodilation which increases blood flow and theoretically helps bring nutrients to the area that may aid in recovery. On a much more surface level, warm tissue is more pliable and therefore easier to move and stretch. I don't particularly like hot packs myself, but that is entirely out of personal preference.

-Ice Baths- One of the most common recovery methods for professional athletes. I can not say this any louder, this sh*t is f*cking stupid. It is dangerous and in some extreme cases it can f*cking kill you. I don't care who swears by it I did my research and I was unable to find any scientific evidence supporting the benefits of an ice bath. Well, actually it can be useful in cases of extreme fever to help lower the body temperature but that's not really what we're talking about here now, is it? Just think about this logically for a second. You just went and worked out. Your body temperature is elevated as is the activity of your cardiovascular system. Your vasculature is dilated and blood is pumping through your muscles. All of this is aided by your elevated temperature (that's why it's called WARMING up.) Now tell me, do you think it makes sense to then go jump into an ice cold water bath? You are basically giving your body an environmental stimulus that has the exact opposite effect of working out and it happens in a much faster, much more punctuated manner. It can cause dangerous fluctuations in heart rate and blood pressure and may lead to a cardiac event. Also, at what f*cking point were we able to convince ourselves that hypothermia is good for you? Hm? Where did we get that idea? I don't get it. If you want to join a polar bear club as an expression of your personal bad-assery, have at it hoss. Just don't tell yourself that you're doing it for your health, because you aren't.

-Contrasts Baths- Contrast baths/therapies are modalities where you alternate between periods of high and low temperatures. In general contrast therapy is performed on specific body parts rather than on your entire body but as far as I can tell from the research this is more a matter of practicality than efficacy. It's easier to submerge your hand in two different buckets than to set up two different temperature baths.

Now I know what you may be thinking. I just told you ice baths are bad for you. I'm not retracting my statement. The difference here is that when alternating between hot and cold you are causing alternating vasoconstriction and dilation. There seems to be some evidence that this alternating "pumping" action helps to alleviate pain and speed recovery. Apparently it helps move metabolic garbage out of you muscles and lymphatic system by indirectly massaging your physiological plumbing. Kind of strange and in my four years in a clinic I only saw it used twice, but it seemed worth mentioning at the very least.

5) Active Recovery - This is exactly what it sounds like. There is a large body of evidence that one of the best ways to speed recovery is to keep moving. We see it in injury rehab with maintenance of range of motion (if you stop moving following surgery, you may permanently lose range of motion due to scar tissue formation) and we see it in athletics with what's called the Repeated Bouts Effect. It may be a little counter intuitive but the basic principle is very simple. So your legs are sore from those squats you did yesterday? Go do some squats today and you'll feel better.

I know. As I said it may sound like the opposite of what you should be doing but the point is not to do the same workout, it's to put your body through similar movements. If you squatted 315 for sets of 5 on monday, you shouldn't do the same thing on tuesday. It may, however, be beneficial to do a couple of bodyweight squats or sets with a lighter weight. Basically what happens when you do this is some combination of a lot of the stuff we've already covered. You are doing active stretching and mobility by repeating the movement through the full range of motion. You are warming your muscles up and enhancing their ability to stretch and move, you're just doing it with activity rather than temperature therapy. On top of that, you're also doing a lot of what contrast therapy does the difference is that instead of vasoconstriction/dilation, the alternating flexing and relaxing of your muscles is causing the pumping effect.

6) Non-Steroidal Anti Inflammatory Drugs (NSAIDs) - I'm not a doctor and therefore I am not comfortable recommending the use of any pharmaceutical substance for any reason. It really just isn't my place. What I would offer you instead is some research I've seen regarding the use of NSAIDs as a recovery aid. It seems in most cases, while they are useful for managing pain, they may actually blunt the training response. In other words, NSAIDs may negatively affect your gains. Working out causes trauma to your body on a microscopic level. In general, where there is trauma, there is inflammation. It is a natural part of the healing process. The theory is that by blunting the inflammatory process, you may actually be blunting the healing process and therefore reducing muscular recovery and growth. The exact mechanism for this is still not understood as far as I know.

Curiously enough, in older adults (50yrs +) NSAIDs actually seem to have the opposite effect. Unfortunately this was only seen in one study, and again, the mechanism proposed was highly hypothetical.

Personally I try to avoid NSAIDs as much as possible to deal with workout soreness. I prefer to use drugs when absolutely necessary, not just when I'm slightly uncomfortable.

7) REST (***SLEEP***) - This may seem obvious but apparently it just isn't to a lot of people. If you are working out twice a day, 6 days a week and wondering why it is that you're perpetually sore maybe you're just doing too much. I know that's not what you want to hear but tough. It's the truth. Your body needs periods of rest to recover and progress. If you aren't resting, not only are you impeding your individual workouts, you are severely impeding your overall progress. Physiological changes occur by and large when your resting, not when you're at the gym. Spending more time away from the weight room floor might do your body good.

It's also important to note that if you are highly active you need to get regular sleep. In some ways Sleep may be the most important variable in your recovery. Everyone has different requirements for sleep but in general if you're active you should be shooting for 8-10 hours of sleep a night. I know it seems like 6 hours isn't that much of a difference but I guarantee you your body will notice. If you rain hard and only sleep for 6 hours a night for weeks on end eventually the neurological fatigue and physical strain will catch up to you. Get your sleep. No excuses. In terms of progress sleep is every bit as important as proper programming. Every. Bit. Think about that.

8) Appropriate Training Volume - This is pretty directly related to rest but not quite the same thing. Training volume can be looked at on different time intervals - hourly, daily, weekly etc. One of the most common causes of inadequate recovery is having far too much volume. It may be that you're doing too much every week, or it may be that you just spend too much time in the gym every time you're there. You don't need to be in the gym for 2 hours pretty much ever. You just don't. Athletes may train for several hours a day every day but that training includes skills practice, strategy sessions, running plays and gameplay fundamentals. They aren't working out for four hours a day and you shouldn't be either.

9) Supplementation - Personally I hate this subject. It's not that supplements don't work nor that they don't have their appropriate place in a training program, it's that far too often people imbue supplements with a power they simply do not have. No magical pill or powder exists that you can just go to the store and chug down tonight then wake up tomorrow morning in perfect physical condition. The closest thing I can think of is HGH and not only is it a controlled substance, but even HGH won't solve your problems overnight. I like whey protein because it makes life easier and BCAAs seem to be all the rage in supplementation these days but you guys should all realize something. As long as there is a demand for something, people will try to sell it to you. Whether or not that thing actually exists is completely irrelevant. Just because some tub at vitamin shoppe has post workout recovery plastered all over it doesn't mean it's going to turn you into the hulk. Look at the supplement facts...usually those supplements are some combination of vitamins, protein and carbohydrates. If your nutrition is on point you don't need supplements.

I'm not saying you shouldn't ever use supplements. Like I said before, I know a fair amount of people who really like BCAAs. Whether or not those aminos are really helping them recover faster, these people are feeling less sore and more energized for their workouts. The placebo effect can be a beautiful thing. All I know is that BCAAs are expensive as hell, and I'm not about to recommend an expensive dietary supplement that is essentially fancy protein. If you want to give it a try by all means be my guest, but don't let anyone tell you you need it, 'cuz you don't.

A lot of times when people ask m about recovery it seems like they're looking for a magical solution. They want some supplement, some powder or pill that they can just go and buy and chug down tonight that's going to solve all of their problems. Or they want some series of exercises - 1 series of exercises for everyone and every body - that's going to alleviate all of their pain and soreness. I'm sorry guys but this sh*t doesn't exist. If it did and I had it to offer you I wouldn't be writing blog posts in my underwear.

I mean...from my office in my fancy under armor workout gear. Yea...

Well, there you have it. The most important aspects of post workout recovery to the best of my knowledge. I'm happy to answer any questions or respond to any comments you guys might have. You know where to leave 'em.